Vital root resection in severely furcation-involved maxillary molars: Outcomes after up to 7 years

Aims: To introduce a novel therapeutic approach for the treatment of furcation-involved maxillary molars by vital root resection and report longer-term outcomes of a case series.

Methods: Eleven patients with 15 maxillary molars affected by double/triple class II (n = 10) or single/double class III (n = 5) furcation defects and advanced vertical bone loss around one root participated. Teeth were treated with deep pulpotomy using a calcium silicate-based cement. After 4 weeks, the affected roots were removed by periodontal microsurgery and processed for histological evaluation of the pulp. All patients were enrolled into a supportive periodontal care programme. During the follow-up period, assessments of tooth sensitivity, response to percussion, mobility, pocket probing depth (PPD) and bleeding on probing (BOP) were made, periapical radiographs obtained and patient-reported outcomes collected.

Results: All teeth remained sensitive to pulp testing. After 1 year and 3-7 years of follow-up, PD was ≤5 mm at all resected teeth. Furcation status was much improved. Neither increasing mobility nor clinical or radiographic signs of periapical pathology were observed throughout the individual observation period. All patients were pleased with the result of therapy. Histologic sections revealed a functional dentin-pulp complex.

Conclusions: This case series demonstrates the possibility of maintaining severely furcation-involved molars by vital root resection for up to 7 years. Root canal therapy and its associated costs and complications can thus be avoided.